MIDYEAR POST GRADUATE INTERNS ORGANIZATION 2017

PHARMACOLOGY PGI COMPRE RECALL & RATIO

DECEMBER 2017
DISCLAIMER: This document is not the answer key. Exam questions were only recalled and rationalized by PGI’s. Study at your own risk!

CARDIOVASCULAR DRUGS
1. Which of the following is TRUE about the use of diuretics in patients with heart failure?
A. K sparing diuretics are given in patients with HF because these diuretics are more potent – K sparing
diuretics such as Spironolactone and Eplerenone are weak diuretics only
B. Patients with HF require higher dose of diuretics because they tend to develop diuretic resistance –
increasing the dose may be an effective strategy because it compensates for the changes in the
pharmacokinetics and dynamics that occur in patients with CHF
C. Patients with HF require low dose thiazide because they become very sensitive to its effects
D. Diuretics are contraindicated in patients with HF who are also oliguric – ACEi’s are contraindicated in HF
patients with reduced renal function. Diuretics are desired to increase urine output.

2. A 56 y/o female diagnosed to have NYHA class IIB was given Digoxin and Furosemide. After 4 months of
therapy, which of the following may be seen on ECG?
A. Increased PR interval – Digoxin causes a decrease in AV node conduction, thereby prolonging the ERP of
the cardiomyocytes, allowing it to have a “breather period”
B. Widened P wave
C. ST segment elevation – ST segment depression or sagging should be observed “reverse tick”
D. Widened QT – QT interval will be shortened
Digoxin or Digitalis effect on ECG can either be therapeutic: ST-segment depression, flattened or inverted T-
wave, shortening of the QT interval; or toxic: T-wave inversion, arrhythmias.

3. A 40 y/o diabetic hypertensive was experiencing dizziness and headache. Upon CBG monitoring, she noted
her blood sugar to be dangerously low. Which drug most likely masked the symptoms of hypoglycemia in this
patient?
A. Amlodipine
B. Irbesartan
C. Metoprolol – beta-blockers can prolong or mask the symptoms of hypoglycemia in diabetic patients who
are taking insulin or other anti-DM medications
D. Captopril

4. Which of the following agents used in the treatment of hypertension is CORRECTLY matched to their
pharmacological action?
A. Furosemide – prevent volume expansion associated with nitroprusside
B. Irbesartan – significantly lowers cardiac output – primary beta-blocker effect, Irbesartan is an ARB
C. Guanethidine – reduces PVR more than cardiac output – econdary beta-blocker effect, Guanethedine is a
postganglionic sympathetic nerve terminal blocker of Norepinephrine
D. Penbutolol – lowers cardiac output by increasing venous pooling – alpha-antagonist effect, Penbutolol is
a nonselective beta-blocker
 5. A 68 y/o male was seen in the ER because of difficulty of breathing and Grade 2 bipedal edema. He had 2
pillow orthopnea and BP was 180/100. He was diagnosed to have heart failure. Which of the following
diuretics should be given?
A. Hydrochlorothiazide – thiazide diuretics inhibit NaCl transport in the DCT
B. Mannitol – osmotic diuretic
C. Furosemide – major application of loop diuretics is in the treatment of edematous states such as in HF,
ascites and acute pulmonary edema. May induce hypokalemic metabolic alkalosis as adverse effect.
D. Spironolactone – potassium sparing diuretic
E. Adipose – adipose should be lost, not given

6. A patient with glaucoma was given a diuretic to reduce intraocular pressure. The major limiting factor in the
prolonged use of this drug is:
A. Metabolic alkalosis
B. Respiratory acidosis
C. Metabolic acidosis – Acetazolamide is a carbonic anhydrase inhibitor widely used in the treatment of
glaucoma. It works by reducing the secretion of aqueous humor. Prolonged usage of Acetazolamide
predisposes the patient to metabolic acidosis due to blockade of bicarbonate reabsorption in the PCT
D. Gynecomastia

7. A patient develops dry mouth, blurred vision and constipation while on an antiarrhythmic. Which replacement
drug of the same class is preferred in this case?
A. Propafenone – class IC antiarrhythmic, most potent sodium blockade
B. Quinidine – class IA antiarrhythmic with moderate antimuscarinic effect
C. Disopyramide – this antiarrhythmic is the culprit for the extracardiac atropine-like effects manifested by
the patient in the case, such as urinary retention, dry mouth, blurred vision, and constipation
D. Procainamide – best answer, also a Class IA antiarrhythmic with weakest antimuscarinic effect, making it
an ideal replacement to Disopyramide

ANTICOAGULANTS
8. Which of the following is an anti-clotting drug that binds to and inhibits the platelet Glycoprotein IIb/IIIa
protein?
A. Aspirin – inhibits prostaglandin thromboxane A2 synthesis by irreversible inhibition of cyclooxygenase
B. Clopidogrel – inhibits ADP induced platelet aggregation by irreversibly binding ADP receptors
C. Enoxaparin – a type of LMWH which acts as factor Xa inhibitor, antithrombotic
D. Tirofiban – MOA is blockade of glycoprotein IIb/IIIa receptors on platelets

9. Which test or finding do you most likely expect to be altered as a result of prior aspirin use?
A. Activated Partial Thromboplastin Time – monitors the anticoagulant action of Heparin
B. Bleeding Time – prolonged by prior Aspirin use
C. International Normalized Ratio – an INR of 2.0-3.0 is ideally maintained in patients taking Warfarin
D. Prothrombin Time
Aspirin has no effect on PT, APTT and INR. Aspirin acts as a platelet inhibitor and PT, APTT and INR are not
dependent on platelet function.

10. By what mechanism does Alteplase cause its beneficial effects?

A. Blocking platelet ADP receptors – Clopidogrel and Ticlopidine
B. Inhibition of synthesis activation of prothrombin and factors VII, IX, and X – Warfarin, Coumadin
C. Blocking of glycogen IIb/IIIa receptors – Tirofiban, Abciximab and Eptifibatide
D. Promotes conversion of plasminogen to plasmin – human tissue plasminogen activator that activates
fibrin-bound plasminogen, fibrinolytic drug
PHARMACOKINETICS
11. The following drug/s when given orally may lose its/their activity due to reactions in the GIT that compete
with absorption
A. Isoproterenol – intravenous
B. Levodopa – oral preparation, effectiveness is reduced in the presence of food with high protein content
C. Amikacin – intravenous
D. A and B only

12. The bioavailability of a drug reflects the

A. Rate of elimination of a drug from the body – clearance
B. Amount of drug absorbed after an oral administration – bioavailability is the fraction of unchanged drug
reaching the systemic circulation following administration by any route
C. Fraction of drug not extracted by the liver after an oral administration – first pass hepatic elimination
D. Difference of drug absorbed and eliminated immediately after IV administration

13. (Question in number 11 repeated verbatim)

14. The volume of distribution of a drug will affect the following EXCEPT:
A. The clearance of a drug - clearance is equal to volume of distribution times elimination constant,
increasing the Vd will also increase the clearance
B. The elimination of a drug
C. The half-life of a drug – an increase in Vd will prolong the drug’s half-life
D. Plasma steady state concentration a drug – variation of Vd mainly affects the PEAK plasma concentration
of the drug which is maintained in order to achieve the therapeutic effect, not the STEADY state plasma
concentration which is reached when the rate of drug input is in equilibrium to the rate of elimination
Volume of distribution represents the fluid volume required to contain the total amount of absorbed drug in
the body.

15. If a drug given orally has a hepatic extraction ratio of 1 and the blood flow to the liver is 1500 mL/min, it means
that
A. The drug given has low bioavailability
B. The drug was 100% absorbed
C. 1500 mL of drug is eliminated in the liver per minute
D. All of the above – extraction ratio is the effect of first-pass hepatic metabolism on bioavailability, the
higher the ER, the lower the bioavailability

PHARMACODYNAMICS
16. The distribution of a drug is said to be perfusion rate limited if the drug is
A. Polar – permeability rate limitation applies to large, hydrophilic, polar or ionized molecules
B. Highly charged
C. Unionized – perfusion rate limited kinetics tend to occur for small, lipophilic, nonpolar or unionized
molecules where the blood flow to the tissue becomes the limiting process for its distribution
D. Highly protein bound

17. Which type of receptors play a major role in neurotransmission, cardiac and muscle contraction?
A. Intracytoplasmic – steroid receptors
B. Transmembrane enzyme-linked – insulin receptors
C. Transmembrane G protein-coupled – activates a membrane G protein that modulates an enzyme or
channel. GPCRs are the most common type of receptors in the body which also play a role in
neurotransmission, vision, gustation, olfaction, immune response and autonomic functions
D. Transmembrane ion channels
 18. In state-dependent ion channel blockade, antiarrhythmics have preference for binding to receptors in
abnormally firing cells because these are in which conformation?
A. Open
B. Closed
C. Refractory
D. Resting
Ion channels can change into various conformational states. Antiarrhythmics bind to one conformation of the
channel with higher affinity than to other conformations. The higher affinity of Na channel blockers to OPEN
and inactivated states of the channel allows these drugs to act preferentially on ischemic tissues and block
impulses from possible arrhythmogenic foci.

19. What is TRUE regarding the type of receptor that insulin has affinity for?
A. It is a ligand-gated transmembrane ion channel
B. The intracytoplasmic portion has attached G-proteins
C. The entire receptor structure is intracytoplasmic
D. Activation of intracytoplasmic domain stimulates tyrosine kinase – involves phosphorylation of
cytoplasmic proteins

20. A person taking Aspirin for maintenance cardioprotection is to undergo elective surgery and was advised to
stop taking the drug a week prior to the procedure because of potential bleeding. The type of antagonism
responsible for this extended effect is
A. Reversible competitive
B. Reversible noncompetitive
C. Irreversible noncompetitive – Aspirin is an irreversible enzyme inhibitor of cyclooxygenase. Other
examples of irreversible noncompetitive inhibitors include Omeprazole and MAOi’s
D. Physiologic

21. Spironolactone is a competitive antagonist of Aldosterone for the active site in sodium channels in the
collecting tubules of the nephron. What is TRUE regarding Aldosterone?
A. The drug binding to the active site is likely to be covalent – false, covalent bonding is for irreversible
antagonists only
B. Antagonist effect of Spironolactone can be surmounted by increased Aldosterone levels – in reversible
competitive antagonism, high agonist concentrations can overcome inhibition by a competitive antagonist
C. Spironolactone stabilizes activated binding site in sodium channels in the collecting ducts
D. Addition of Aldosterone will increase efficacy of Aldosterone to open sodium channels

22. (Question in number 20 repeated verbatim)

23. Given “(Response/Max response) as [DR]/[Ro] = [D]/[D] + Kd” and two antibiotics with the same bacterial
coverage. Drug A has a Kd of 1.89 while drug B has a Kd of 4.32. What is a correct comparison given equal
drug concentrations?
A. Response will be greater for drug B
B. Drug A will produce greater patient response – the higher the dissociation constant (Kd), the lower the
absorption
C. Drug B is more potent than Drug A
D. A and B
E. B and C

ADRENERGIC-CHOLINERGIC DRUGS
24. Of the following beta blockers, this drug is lipophilic and crosses the blood-brain barrier
A. Atenolol – hydrophilic, beta-1 selective, without intrinsic sympathomimetic activity
B. Labetalol
C. Esmolol
D. Propranolol – highly lipophilic, nonselective, without intrinsic sympathomimetic activity
25. A 62 y/o male is suffering from exertional dyspnea. He had been diagnosed to have chronic heart failure after
being hospitalized from myocardial infarction. This would be the preferred maintenance drug
A. Dobutamine – for acute HF only, beta-agonists are not appropriate for chronic due to tolerance, lack of
efficacy and arrhythmogenic effects
B. Isoproterenol
C. Metoprolol – only Metoprolol, Bisoprolol and Carvedilol have been FDA approved for the Tx of CHF
D. Esmolol

26. This is the most common adverse cardiac effect of beta blocking drugs:
A. Cold hands
B. Fatigue
C. Bradycardia – the only cardiac adverse effect among the choices, beta-blockers cause a decrease in
chronotropy (rate), inotropy (contractility), lusitropy (relaxation rate), dromotropy (conduction velocity)
D. Hypotension

27. LS, 60 y/o male was diagnosed to have glaucoma. His doctor decided to give this selective alpha-2 adrenergic
agonist:
A. Apraclonidine – alpha-2 agonist
B. Latanoprost – prostaglandin analog
C. Timolol – beta blocker
D. Physostigmine - parasympathomimetic

28. This nonselective beta blocker is useful in hypertension, migraine and in patients with “performance anxiety”:
A. Propranolol – beta blocker, drug of choice for performance anxiety
B. Metoprolol
C. Isoproterenol
D. Esmolol

29. Which of the following postreceptor mechanisms is associated with Bethanechol?

A. Increase phospholipase activity in the endothelial cells – Bethanechol is a muscarinic cholinomimetic
agent acting at the cholinergic receptors in the smooth muscle of the urinary bladder and GIT
B. Enhance adenylyl cyclase activity in the CNS – does not cross the BBB, minimal CNS risk
C. Decrease potassium conductance at myocardial cells – negligible effect on the CVS
D. Activate sodium channels at motor plates

30. What agent would be the most appropriate management if the child, who accidentally ingested Malathion,
was brought to the hospital 36 hours from the time of ingestion?
A. Atropine – antidote to organophosphate, purely antimuscarinic, paralysis is a dreaded adverse effect
B. Pralidoxime – direct antidote to organophosphate, but must be administered in the first 36-48 hrs to
reactivate acetylcholinesterase prior to aging
C. Pyridostigmine – antidote to organophosphate, reversible acetylcholinesterase inhibitor
D. A and B only
E. All of the above
Malathion is an irreversible acetylcholinesterase inhibitor used as pesticide, Malaoxon is the active toxic
metabolite which manifests as symptoms of organophosphate poisoning

31. Which of the following adverse effects is associated Methacholine?

A. Bradycardia
B. Hypotension
C. Rhabdomyolysis – not a documented adverse effect of Methacholine
D. A and B only – Methacholine is a cholinoceptor agonist primarily used to diagnose asthma and COPD. It’s
use is limited by its adverse effects which include bradycardia, bronchoconstriction and hypotension
E. All of the above
LIPID-LOWERING AGENTS
32. A 60 y/o male diagnosed to have coronary heart disease and uncontrolled DM has LDL of 130 mg/dL, which
of the following recommendations is most appropriate?
A. Instruct on lifestyle modification – cornerstone in the management of any dyslipidemic disease
B. LDL goal is below 100 mg/dL – indicated LDL goal for known CHD patients
C. Preferably treat with Colesevelam – not proven to produce results in CHD risk reduction
D. A and B only
E. All of the above

33. A 50 y/o non-hypertensive, non-diabetic male consulted after 3 weeks of intake of a lipid lowering agent. His
HDL was noted to increase by 30%, as well as a reduction in LDL by 15% and Triglycerides by 45%. Which of
the following agents will be most appropriate for this case?
A. Colesevelam
B. Gemfibrozil
C. Niacin – most effective agent at lowering triglyceride and VLDL levels
D. Rosuvastatin

34. A female patient with familial dysbetalipoproteinemia was noted to have 500 mg/dL of Triglycerides. For this
case, which of the following will most effectively reduce triglyceride levels?
A. Gemfibrozil
B. Niacin
C. Colestipol + Niacin
D. Gembfibrozil + Omega-3 fatty acid – combination therapy is ideal for mixed dyslipidemias, fibrate + omega
3 FA will best address the patient’s hypertriglyceridemia

35. A 55 y/o obese male at high risk for coronary artery disease initially had a 190 mg/dL LDL and 170 mg/dL
Triglycerides. He was prescribed with Atorvastatin. After 4 weeks, his LDL level is 110 mg/dL and Triglycerides
by 162 mg/dL. Which of the following treatment schemes is preferred in this case?
A. Continue Atorvastatin
B. Combine Atorvastatin with Fenofibrate – goal LDL for this patient is <100 mg/dL, we continue Atorvastatin
because it has markedly reduced the patient’s LDL levels. Addition of a fibrate will improve triglyceride
reduction which was only marginally reduced with monotherapy of Atorvastatin.
C. Discontinue Atorvastatin and start Gemfibrozil
D. Shift Atorvastatin to Colestipol

ANTI-THYROID DRUGS
36. The preference of Levothyroxine over Liothyronine is because it has
A. Higher oral bioavailability
B. Greater potency – Liothyronine is 3-4x more potent than Levothyroxine
C. More constant oral absorption – Levothyroxine is safer because Liothyronine is absorbed in the intestines
very rapidly, which might cause mild thyroid hormone toxicity
D. Capability to establish a physiologic state of T4-T3 concentration
E. All of the above

37. Methimazole reduces serum concentration of T3 primarily by:

A. Accelerating the peripheral metabolism of T3 – inhibits peripheral deiodination of T4 to T3
B. Inhibiting the proteolysis of thyroid-binding globulin
C. Inhibiting the secretion of TSH
D. Inhibiting the uptake of Iodide by cells in the thyroid – MOA of Anion Inhibitors
E. Preventing the addition of Iodine to Tyrosine residues on thyroglobulin – MOA of Thioamides
 38. This drug is given 7-14 days before surgery to reduce the vascularity of the thyroid gland:
A. Levothyroxine
B. Liothyronine
C. Lugol’s solution – iodides are used to decrease the size and vascularity of the gland as preoperative
preparation prior to thyroid surgery, Sig. 5 drops BID x 10-14 days prior to surgery
D. Prednisone
E. Radioactive Iodine – slow onset of effect, shrinkage in thyroid gland size seen after 6-12 weeks from admin

39. Relative to Lugol’s solution, Propylthiouracil has:

A. A faster onset of antithyroid action - PTU slower, Lugol’s solution produce discernable effect after 24 hrs
B. A greater inhibitory effect on the proteolytic release of hormones from the thyroid gland
C. Increased likelihood of causing exophthalmos during the first week of treatment
D. Increased risk of fetal toxicity – decreased risk, PTU is safer to use in pregnant patients
E. More sustained antithyroid activity when used continuously for several months

40. A man is given a drug to reduce thyroid gland size and vascularity before surgical thyroidectomy. Which
mechanism is responsible for its use in this setting?
A. Inhibition of the Sodium/Iodide symporter
B. Inhibition of thyroperoxidase
C. Inhibition of TSH secretion
D. Inhibition of thyroid hormone release – by inhibiting thyroid hormone synthesis and release, thyroid gland
vascularity is reduced, thyroid tissue becomes firmer and cell size is decreased
E. Destruction of thyroid tissue

ANTI-DIABETIC DRUGS
41. A 50 y/o obese female consulted due to frequent urination (polyuria) and feeling of thirst (polydipsia). Her
FBS is 180 mg/dL and post-glucose load blood sugar level is 220 mg/dL. Fasting insulin blood level is elevated.
Which of the following agents will be most preferred for this case?
A. Insulin
B. Metformin – regarded as the 1st line treatment for newly-diagnosed DM patients
C. Rosiglitazone
D. Sitagliptin

42. A 38 y/o male diagnosed with DM is on Insulin therapy. Immediately after regular Insulin subcutaneous
injection he had a hot bath. Which of the following is expected?
A. Early hyperglycemia
B. Delayed peak of Insulin
C. Increased blood Insulin level
D. Partial loss of rapid acting effect – increased heat will cause protein denaturation and this will reduce the
potency of insulin, this is also why insulin vials are stored under cold temperatures to preserve its potency

43. Which of the following cases of DM will have increased Insulin requirement?
A. 25 y/o female with normal BMI newly diagnosed case – best response to insulin
B. 30 y/o obese male – large volume of distribution will equate to increased insulin requirement
C. 40 y/o female with DM for 20 years
D. 55 y/o male with end-stage renal failure – impaired renal function, likely to have low Vd

44. A 65 y/o diabetic male was brought to the clinic due to diaphoresis, slurred speech, and motor incoordination.
His current blood glucose level is 50 mg/dL. What agent/s could this side effect be most common?
A. Glimepiride – hypoglycemia is a notorious adverse effect of most sulfonylureas
B. Glyburide
C. Rosiglitazone
D. Sitagliptin
 45. A 42 y/o obese diabetic has concurrent congestive heart failure. Which of the following antidiabetic agents is
CONTRAINDICATED in this case?
A. Repaglinide
B. Pioglitazone – fluid retention is a known adverse effect of thiazolidinediones, this is disastrous for DM
patients with concomitant obesity and congestive heart failure, making them prone to fluid overload state
C. Nateglinide
D. Glipizide
E. Pancreatitis

46. A patient newly diagnosed with DM II will be given an oral hypoglycemic agent. On further inquiry she
mentioned to have history of allergy with sulfonamide antibiotic. Which agent may be CONTRAINDICATED in
this case?
A. Acarbose
B. Glibenclamide – sulfonylureas have a sulfonamide component, contraindicated in Px with sulfa allergy
C. Rosiglitazone
D. Sitagliptin

GASTROINTESTINAL DRUGS
47. While taking an antacid for his peptic ulcer disease, the patient developed renal insufficiency and
hypercalcemia. Which of the following drugs can cause these side effects?
A. Calcium carbonate (Tums)
B. Sodium bicarbonate (Alka Seltzer)
C. Al/MgOH (Maalox) – absorbed and excreted renally, not to be taken long-term by Px w/ renal insuff
D. A and B only – excessive doses of Sodium bicarbonate or Calcium carbonate with Calcium-containing dairy
products can precipitate hypercalcemia, renal insufficiency, and metabolic alkalosis (milk-alkali syndrome)
E. All of the above

48. Reason/s why Cimetidine cause/s gynecomastia and galactorrhea:

A. Cimetidine inhibits binding of dihydrotestosterone to androgen receptors
B. Cimetidine inhibits metabolism of estradiol
C. Cimetidine increases serum prolactin levels
D. A and B
E. All of the above – Cimetidine is an H2 Antagonist which when in long term or high doses, can cause
gynecomastia or impotence in men and galactorrhea in women via the three reasons listed above

49. A patient given a PPI with Bismuth subsalicylate for H.pylori eradication experienced this adverse effect:
A. Melanosis coli – caused by anthranoid laxatives such as Senna
B. Uterine contractions - abortifacient property of the prostaglandin analog, Misoprostol
C. Abdominal cramps
D. Black stool and tongue – Bismuth is known to cause harmless blackening of the stool and tongue
E. Extrapyramidal symptoms – secondary to antipsychotic medications

50. Which of the following drugs causes 5-HT3 receptor blockade in the vomiting center?
A. Alosetron – 5-HT3 antagonist
B. Cisapride – 5-HT4 receptor agonist, gastroprokinetic, parasympathomimetic
C. Prucalopride – 5-HT4 receptor agonist
D. Tegaserod – 5-HT4 receptor agonist
E. Hyoscine – aka Scopolamine, used to treat motion sickness and post-op nausea and vomiting
RESPIRATORY DRUGS
51. A 54 y/o male was rushed to the ER due to severe chest tightness and difficulty of breathing. The resident
physician wanted to administer the drug subcutaneously. Which of the following is the best choice?
A. Terbutaline – indicated for relief of acute asthma attack, may be given subcutaneously
B. Epinephrine – obsolete in the treatment of acute asthma
C. Salbutamol – SABA, inhalational
D. Salmeterol – LABA, inhalational

52. Which of the following is TRUE regarding delivery system of drugs used in the treatment of asthma?
A. Particle of MDI is much larger than nebulized therapy thus more effective – false, nebulized particles are
much larger, too large for effective drug delivery to the lungs
B. Dose of nebulizer is about 25 to 50 mg inhaler which is 100-400 mcg but are no more effective
C. Nebulized therapy should be reserved for patients unable to coordinate from MDI – nebulization provides
a vehicle for drug delivery to patients who are too ill or too young to use other portable inhaler devices
D. Most preparation are mixture of R and S isomers that activates the beta agonist receptors

53. Which is TRUE of Ipratropium bromide?

A. A derivative of Atropine
B. Can be given in high dose by inhalation
C. Poorly absorbed into the circulation – minimal systemic effects
D. All of the above

54. TRUE of Glucocorticoids:

A. They relieve the smooth muscle obstruction
B. Their action is mainly in the lymphocytes, eosinophils and mast cells – glucocorticoids inhibit cell-
mediated immunologic functions, especially those dependent on lymphocytes, eosinophils, basophils
C. It is commonly used in combination

55. Which of the following is TRUE of Montelukast?

A. Mostly prescribed drug – for asthma and allergic cough
B. Can be taken without meals – high safety profile
C. Given on once daily basis – long half-life allows once daily dosing
D. All of the above

OPIOIDS AND ANALGESICS

56. Thiopental is highly lipid soluble. What is expected with regard to its sedative action?
A. Rapid onset, long duration
B. Rapid onset, short duration – Thiopental is an ultrashort-acting CNS depressant which produces hypnosis
within 30-40 secs, recovery after a small dose is also rapid, with some somnolence and retrograde amnesia
C. Slow onset, long duration
D. Slow onset, short duration

57. Respiratory depression due to opioids is mediated primarily by what receptor stimulation?
A. Mu – postsynaptic, supraspinal analgesia, respiratory depression is the dreaded toxicity
B. Kappa – presynaptic, spinal analgesia, sedation/dysphoria
C. Sigma – not important in analgesia
D. Delta – dysphoria, hallucinations, pupilodilation
CNS-ACTING DRUGS
58. A patient is taking an antidepressant. After a wine and cheese party, she develops severe headache,
palpitations, and elevated BP. The drug taken by the patient is most likely a
A. Monoamine Oxidase Inhibitor – because gastric monoamine oxidase effectively prevents dietary pressor
amines such as tyramine from entering the tissues, a marked hypertensive response can occur when
subjects treated with MAOi’s ingest tyramine-rich food or beverages (wine and cheese)
B. Selective Serotonin Reuptake Inhibitor
C. Tricyclic Antidepressant
D. Serotonin-Norepinephrine Reuptake Inhibitor

59. This antiviral agent is useful in patients with Parkinson’s disease

A. Amantadine – enhances dopaminergic neurotransmission, also with muscarinic blocking actions
B. Efavirenz
C. Oseltamivir
D. Ribavirin

60. A male schizophrenic patient on typical antipsychotics complains of orthostatic hypotension. This adverse
affect is mediated by which receptor blockade?
A. Adrenergic
B. Histaminergic
C. Muscarinic
D. Serotonergic – typical antipsychotics are classified as Serotonin-Dopamine Antagonists

61. Which of the following can be used in heavy metal poisoning?

A. Dimercaprol – also known as British Anti-Lewisite (BAL), binds Arsenic and other heavy metals
B. Dimercaptosuccinic acid – antidote to Arsenic, Lead and Mercury poisoning
C. EDTA – heavy metal chelating agent, used as antidote in Lead poisoning
D. Penicillamine – antidote to Copper poisoning
E. All of the above

62. Which of the following can be used in the management of Dichlorvos poisoning?
A. Atropine
B. Methylene blue – may be used in methemoglobinemia
C. Pralidoxime
D. A and B
E. A and C

63. A chemical with an estrogenic activity may act through

A. Direct ER activation
B. Anti-androgenic effects
C. Acting as or altering a co-activator of the receptor-ligand interaction
D. Decreasing clearance or catabolism of estrogen by inhibiting metabolizing enzymes
E. All of the above

64. Which of the following drug classes have a CNS depressant effect?
A. 1st generation antihistamines
B. Alcohols
C. Barbiturates
D. Benzodiazepines
E. All of the above
 65. Ramelteon binds to which receptors in order to promote hypnosis?
A. GABA
B. Melatonin – Ramelteon is a novel Melatonin receptor agonist used in the treatment of insomnia
C. NMDA
D. Serotonin

66. Which of the following drugs can be used for status epilepticus?
A. Diazepam – intravenous drug of choice in status epilepticus
B. Lorazepam – also effective in terminating attacks and providing short-term control
C. Phenobarbital – has also been used in status epilepticus especially in children
D. Phenytoin – can be used for status epilepticus but may cause cardiotoxicity
E. All of the above

67. Valproic acid acts by:

A. Inhibiting T-type Calcium channels
B. Enhancing Sodium-channel mediated inhibition
C. Enhancing GABA-mediated inhibition
D. All of the above

DRUGS OF ABUSE
68. Primary mechanism of action of Cocaine in the CNS
A. Activates post-receptor second messengers
B. Directly stimulates postsynaptic Norepinephrine receptors
C. Inhibits Norepinephrine reuptake in the presynaptic neuron – has marked amphetamine-like effects
“super-speed”, euphoria, self-confidence, mental alertness are short-lasting
D. Stimulates Norepinephrine release in the presynaptic neuron

69. Which antihypertensive may be given to treat a patient with Morphine addiction?
A. Amlodipine
B. Clonidine – this antihypertensive, alpha-2 agonist, centrally-acting sympathoplegic has been used to
facilitate withdrawal in both inpatient and outpatient settings for over 35 years
C. Losartan
D. Metoprolol

70. An unconscious female was found with needle marks on her forearm, and has a very slow respiratory rate and
constricted pupils. She most likely overdosed with
A. Alprazolam
B. Ecstasy
C. Heroin – strong, pure Mu opioid agonist, intravenous overdose leads to pupilloconstriction  respiratory
depression  coma  death
D. Marijuana

71. Chemotherapy-induced nausea and vomiting is best addressed using drugs that antagonize
A. 5-hydroxytriptamine receptors – Ondansetron, Alosetron, Palonosetron, Granisetron
B. Chloride channels in the GIT
C. Histamine receptors
D. Muscarinic receptors
ANTIMICROBIALS
72. A 25 y/o G2P1 at 16 weeks AOG diagnosed with Syphilis developed Jarisch-Herxheimer reaction after receiving
this antibiotic
A. Procaine Penicillin
B. Penicillin K
C. Aqueous Penicillin
D. Penicillin G Na – JHR is a systemic response to the release of pyrogens that occurs soon after the first
adequate dose of antibiotic treatment. This occurs within 6-24 hrs of receiving Penicillin G and is
characterized by the onset of an acute febrile illness, headache, and myalgias.

73. Drug A inhibits the transglycosylase enzyme preventing the elongation of building blocks in peptidoglycan
synthesis
A. Bacitracin
B. Methicillin
C. Vancomycin – glycopeptide antibiotic, inhibitor of transpeptidation and transglycosylation
D. Fosfomycin

74. SF was taking this antibiotic for dental abscess. On her 3 rd day, she experienced abdominal pain associated
with diarrhea. Which is the MOST LIKELY cause?
A. Amoxicillin
B. Vancomycin
C. Clindamycin – DOC for dental abscess, GI intolerance is a known adverse effect
D. Tetracycline

75. TG developed hypoprothrombinemia after taking this antibiotic for 5 days. Which of the following is LIKELY
implicated?
A. Cefamandole
B. Moxalactam
C. Cefmetazole
D. All of the above

76. DP was admitted because of acute pyelonephritis. Her creatinine level was elevated. Which of the following
medications should be administered without adjusting the dose?
A. Ticarcillin
B. Ceftriaxone – renal dosing adjustment is not necessary as long as the dosage is below 2 g or less per day
C. Carbenicillin
D. Piperacillin

77. RL was taking this antibiotic for chronic respiratory infection for 1 week after which she complained of mild
chest pain. ECG finding showed prolongation of the QT interval on ECG. Which is the MOST LIKELY cause?
A. Telithromycin
B. Erythromycin – macrolides (Erythromycin, Clarithromycin), quinolones, antifungals and antimalarials have
been implicated in predisposing to torsades de pointes as a result of QT prolongation
C. Tigecycline
D. Daptomycin

78. The physician is contemplating to give Ciprofloxacin to a 70 y/o female. Based on this data, which of the
following may be appropriate or is expected for the patient?
A. Antibacterial property greatest with large once daily dose
B. Best to avoid full range of exercises – increased risk of tendinitis, tendon rupture, and worsening muscle
weakness in elderly taking fluoroquinolones
C. Nephrotoxicity is a common adverse effect
D. Should not be given since it is contraindicated in this age group
 79. A 35 y/o patient with mild to moderate dehydration has been currently diagnosed to have sepsis. Gentamicin
will be given. His current creatinine clearance is 70 mL/min. Which of the following is considered as a factor
that would enhance Gentamicin’s adverse effect in this case?
A. Age
B. Hydration status
C. Renal function
D. All of the above

80. Which of the following cases would Gentamicin be safely given?

A. 70 y/o with DM nephropathy – highly nephrotoxic
B. 55 y/o with partial hearing loss – ototoxicity may aggravate hearing loss
C. 40 y/o with trough level of 1 mcg/mL – optimal trough level is >2 mcg/mL
D. 30 y/o with 2 liters blood loss during surgery – hypovolemic state, restore euvolemia first

81. A patient with superficial burn wound on the dorsal surface of his left hand would be given an antibiotic to
prevent infection. Which of the following will be most appropriate in this case?
A. Oral Sulfadiazene
B. Topical Sulfadiazene – sulfonamide antibiotic used to treat and prevent secondary infection, topical route
is ideal to avoid systemic effects and sufficient because the degree of the burn is only superficial
C. Oral Sulfasalazine
D. All of the above
E. A and B only

82. A pregnant woman on her 24th week of pregnancy is febrile and suspected to have bacteremia. After 24 hours
of incubation of blood culture, a heavy growth of E.coli was noted. Which of the following agents will be
appropriate to eradicate the organism in this case?
A. Gentamicin – first-line aminoglycoside against Gram-negative infections such as P. aeruginosa, Proteus,
E. coli, Klebsiella, Enterobacter and Serratia
B. Levofloxacin
C. Sulfamethoxazole
D. Trimethoprim

83. If Probenecid will be given with Ofloxacin, which of the following is expected to occur with Ofloxacin?
A. Absorption will be impaired
B. Metabolism will be accelerated
C. Renal excretion will be inhibited – Probenecid will decrease the elimination half-life of Ofloxacin
D. No significant drug interaction

ANTI-TUBERCULOSIS DRUGS
84. PG, a 4 y/o girl was recently diagnosed to have primary pulmonary tuberculosis and is being treated with triple
anti-Koch’s therapy comprised of Rifampicin, Isoniazid and Pyrazinamide. The mother noticed her to have
frequent soft stools and she often complains of on and off abdominal pain. Which of the following can be
done?
A. Discontinue INH
B. Give PZA early in the morning together with Rifampicin and INH
C. Give Rifampicin 2 hours after a meal - best strategy to reduce GI intolerance without compromising
therapeutic response of the patient
D. Discontinue Rifampicin
 85. TS, a 60 year old fishball vendor is diagnosed to have pulmonary tuberculosis. He is a chronic alcoholic with
fatty liver and peripheral neuropathy. He was given Treatment Regimen II which means he qualifies in which
of the following criteria?
A. Chronic (still smear (+) after supervised re-treatment) – Treatment Regimen IV: Refer to specialized facility
B. New Smear ((-) PTB with minimal parenchymal lesions on CXR as assessed by the TBDC) – Regimen III
C. Treatment failure – Treatment Regimen II: 2HRZES/1HRZE/5HRE
D. New Smear ((+) PTB, chest X-ray positive parenchymal lesion) – Treatment Regimen I: 2HRZE/4HR

86. SK a 4 y/o girl weighing 12 kg was diagnosed to have PPTB. How much Rifampicin (200mg/5mL preparation),
INH (200mg/5mL) and PZA (250mg/mL) should be given?
A. 15 mL Rifampicin, 10 mL INH and 35 mL PZA
B. 5 mL Rifampicin, 4 mL INH, 7.5 mL PZA
C. 2.5 mL Rifampicin, 5 mL INH, 15 mL PZA
D. 5 mL Rifampicin, 15 mL INH, 10 mL PZA – not exactly correct, but closest to the computed values without
underdosing
To compute for the appropriate dose of anti-TB drugs for a given patient:
First: Ascertain if the patient is a child or an adult and refer to the table of Dosage Recommendations for Initial
TB Treatment. For a child, we have the following values:
RIF: 15 INH: 10 PZA: 35
Second: Multiply the recommended dose by the given weight of the patient (Weight: 12 kg)
RIF: 60 INH: 120 PZA: 420
Third: Divide the answer by the numerator of the available preparation then round up to whole number
RIF: 0.3 = 1 INH: 0.6 = 1 PZA: 1.68 = 2
Fourth: Multiply the answer by the denominator of the available preparations
RIF: 5 mL INH: 5 mL PZA: 10 mL

ANTIVIRALS
87. SS, a 28 y/o female on her 32nd week of pregnancy was diagnosed to have HIV. Which group of anti-HIV drugs
is not yet recommended for her?
A. Protease inhibitor
B. NRTI
C. NNRTI
D. Integrase inhibitor – can reduce viral load by tenfold but role is still unclear for patients in their late
pregnancy, safety profile is still being investigated in larger studies
There are two optimal treatment regimens as first-line options for pregnant women with HIV: a protease
inhibitor or a NNRTI, plus two NRTI’s.

88. DK, a 44 y/o female developed Herpes Zoster infection. She was prescribed with Acyclovir. Which of the
following is TRUE about this drug?
A. It affects only those cells infected by the virus – selective inhibition to infected cells, the host cells are not
considerably affected
B. It has narrow therapeutic index hence not suitable for neonates – safety and tolerance studies show
Acyclovir to be well tolerated, as a matter of fact it is used in treating neonatal herpes simplex infection
C. It does not require initial activation by viral thymidine kinase – requires viral thymidine kinase
D. All of the above

89. A 36 y/o male with HIV is currently taking 4-drug therapy. He now complains of central fat accumulation.
Which of the following may have caused this?
A. Maraviroc
B. Efavirenz – central fat accumulation with increased abdominal girth, which may include dorsocecal fat
pad and/or gynecomastia in males or breast hypertrophy in females, particularly with Efavirenz
C. Ritonavir
D. Lamivudine
CLINICAL APPLICATIONS OF ANTIBIOTICS
90. A 31 y/o G2P1 at 24 weeks AOG consulted because of dysuria and frequency on urination. Urinalysis revealed
40-50 pus cells. Which of the following medications should be given?
A. Fosfomycin
B. Cefuroxime
C. Nitrofurantoin
D. All of the above

91. A post CS patient consulted because of surgical site infection. Wound discharge was sent for culture which
revealed MRSA. Which of the following is the MOST EFFECTIVE therapy?
A. Polymixin B – systemic antifungal
B. Cloxacillin – anti-staphylococcal penicillin
C. Cephalexin – cephalosporin
D. Vancomycin – DOC for MRSA

92. A 6 y/o boy was bitten by an insect on his right arm. After 2 days, the right arm was noted to be edematous,
erythematous, tender and warm to touch. Which is the LEAST LIKELY medication to give?
A. Ampicillin – good staphylococcal activity
B. Clindamycin – DOC for skin and soft tissue abscesses
C. Cloxacillin – anti-staphylococcal, good for cellulitis
D. Cephalexin – 1st generation cephalosporin

93. DA, was diagnosed with CKD because of long-standing DM. Which of the following medications should not be
administered?
A. Tetracycline
B. Nitrofurantoin
C. Sulfadoxine
D. All of the above – all three drugs have prolonged elimination and are not ideal for CKD patients

94. AS is travelling to Palawan, which of the following should be given for Malaria prophylaxis?
A. Mefloquine – antimalarial pre- or post-exposure prophylaxis, taken one dose, one week before trip
B. Pyrimethamine – antitoxoplasmosis, also 2nd line for Pneumocystis jiroveci pneumonia
C. Sulfadoxine – sulfonamide antimalarial treatment
D. Levofloxacin – fluoroquinolone antibiotic

CANCER CHEMOTHERAPY AGENTS

95. A 45 y/o lady was diagnosed with cervical cancer. Her gynecologic oncologist advised her to receive 6 cycles
of chemotherapy with 25 days of external beam radiotherapy. Which of the following cancer treatment
modalities BEST describes giving chemotherapy?
A. Adjuvant
B. Neoadjuvant
C. Concurrent – chemotherapy simultaneous with radiotherapy
D. Primary induction

96. A 45 y/o male developed sign and symptoms caused by Acrolein. Which of the following MOST LIKELY caused
his problem?
A. Cyclophosphamide – Acrolein is the active, cytotoxic metabolite of Cyclophosphamide and Ifosfamide
B. Bleomycin – oxygen free radicals
C. Methotrexate – polyglutamate metabolites
D. None of the above
97. A 32 y/o lady complained of vaginal bleeding. On pelvic examination, a reddish lesion was noted on the vaginal
wall extending to the labia minora with elevated serum beta hCG. What is the most appropriate
chemotherapeutic agent for her?
A. Methotrexate – DOC for gestational trophoblastic tumors and choriocarcinoma
B. Adriamycin
C. Dacarbazine – DOC for melanoma, Hodgkin’s lymphoma, soft tissue sarcoma and neuroblastoma
D. Carmustine

98. A 55 y/o with immature teratoma complained of difficulty of breathing after few minutes of chemotherapy.
Decreased breath sounds were noted on both lung fields with poor PFT result. This is MOST LIKELY caused by
which agent?
A. Cisplatin
B. Methotrexate
C. Paclitaxel
D. Bleomycin – dreaded adverse effect is life-threatening interstitial pulmonary fibrosis or fibrosing alveolitis

99. The biologic effects of this chemotherapeutic agent can be reversed by administration of Leucoverin. What is
the chemotherapeutic agent?
A. Permetrexed
B. 5-FU – Leucoverin and Folinic acid are the cytoprotective agents of of 5-Fluorouracil
C. Methotrexate
D. Capecitabine

100. Who among these patient has the HIGHEST risk to develop cardiomyopathy?
A. 65 y/o, retired accountant, on her first cycle of chemotherapy
B. 55 y/o, athlete, on her third cycle of chemotherapy – a significant percentage of athletes are predisposed
to have hypertrophic cardiomyopathy, combined with age and number of cycles received, this patient is
at highest risk to develop cardiomyopathy especially when given Doxorubicin, a cardiotoxic chemo agent
C. 32 y/o, movie actress, on her 5th cycle of chemotherapy
D. 40 y/o, politician, on her 6th cycle of chemotherapy